When the sirens go silent: Inside Lagos’ dying emergency ambulance system (2)

In this second part, GODFREY GEORGE digs into the facts: sobering statistics, abandoned policies, delayed reforms, and the staggering gap between public infrastructure and private alternatives. With Nigeria losing up to several lives daily and response time in Lagos far below global standards, to treatable emergencies, the stakes could not be higher

WHO guidelines
In May 2019, the World Health Assembly passed a resolution unanimously recognising the critical role that emergency care systems play in preventing death and disability from acute illnesses and injuries.

While many low- and middle-income countries, including Nigeria, acknowledge the importance of emergency care, they continue to face significant challenges in developing these systems.

Historically, limited resources have been prioritised toward combating infectious diseases and addressing maternal and child health, often leaving emergency services underdeveloped.

Universal health coverage, which ensures access to quality healthcare services without financial hardship, remains a key objective for countries looking to strengthen their emergency care systems.

Yet, Nigeria’s health system has long struggled to meet the needs of its growing population, despite improvements in economic indicators.

Between 2000 and 2019, Nigeria’s gross domestic product per capita rose from $568 to $2,230.

However, its healthcare delivery still lags.

Globally, Nigeria ranks 142nd out of 195 countries in terms of healthcare access and quality.

One of the critical challenges facing the country is the mass exodus of trained healthcare professionals. Nigeria continues to experience one of the highest rates of medical brain drain in the world. The nation’s healthcare infrastructure remains inadequate.

Estimates suggest that over half of all deaths in low- and middle-income countries could be prevented through effective emergency care.

In Nigeria, this could mean saving up to one million lives each year, about 3,000 lives daily.

Despite this staggering potential, emergency departments in the country are often run by providers without any formal training in emergency medicine, as there are currently no nationally recognised postgraduate programmes in the specialty.

Roughly 10 to 15 per cent of Nigeria’s 1.6 million annual deaths are believed to occur within emergency departments.

Lagos is one of the few states that has a public ambulance transport system, but many stakeholders have said some of the vehicles are not functional.

Even when ambulances are operational, navigating the city’s traffic-choked roads poses a major obstacle to timely emergency response.

While healthcare professionals have written extensively about the shortcomings of the Nigerian emergency care system and proposed possible solutions, these perspectives rarely include the views of the general public.

The experts have averred that incorporating feedback from the wider community may offer a more inclusive and effective approach, enabling policymakers to develop emergency care solutions that align with the needs, values, and expectations of the people they serve.

‘LASAMBUS saved my life’
The day Ifeoma lost her newborn, she also found something extraordinary. Not in the bleak hospital corridors of the Nigerian Air Force Base in Lagos, where panic had overwhelmed the medical team, nor in the lifeless stillness of the neonatal ward.

She found it in the blare of sirens and the sudden rush of breath that arrived just in time, but perhaps not early enough.

They saved my life,” she says now, her voice even but weighted. “I had been in labour for hours, and it was not progressing. The baby was becoming distressed and had passed out meconium, which is the first faeces produced by a newborn. There was a need for an emergency caesarean section, but I was told the surgeon was not available. I was already placed on oxygen, and a referral was needed. Sadly, the Air Force Base hospital didn’t have an ambulance equipped with oxygen to take me to another advanced facility. I was crashing. The baby was fading fast.”

Ifeoma, a media expert who has reported health for years, recalls placing one desperate call. Within five minutes, the Lagos State Ambulance Services, known popularly as LASAMBUS, had arrived.

“I remember the blue and white ambulance, gleaming even in the haze of my panic. They came with everything – oxygen, monitors and trained personnel. They stabilised me. They drove me to Isolo General Hospital. They didn’t just save me. They stayed. They waited. They made sure I was alright.”

Her baby didn’t make it. But LASAMBUS did.

A system that worked
In its heyday, Lagos State Ambulance Services was a model of public health responsiveness.

First introduced during the tenure of then-Governor Babatunde Fashola and strengthened under his successor Akinwunmi Ambode, LASAMBUS was more than just a fleet of emergency vehicles; it was a lifeline.

Strategically stationed across the state and seamlessly integrated with LASEMA, the service represented a rare feat: a state healthcare infrastructure that worked.

“When you saw LASEMA, you saw LASAMBUS,” says Ifeoma. “There was no delay. There was coordination. In road accidents, in childbirth emergencies, in critical trauma cases, they were there. You’d barely call before hearing the siren.”

And for a time, it made a tangible difference. Stakeholders in Lagos health circles frequently pointed to the system as an example of life-saving governance.

Ambulances were fitted with oxygen tanks, defibrillators, trained medics, and real-time response mechanisms.

“There were zero deaths at scenes where LASAMBUS intervened promptly,” Ifeoma insists.

Where did it all go wrong?
Reports of long delays, missing ambulances, and near-absent emergency care have become common. During one recent major emergency (details withheld for privacy), an ambulance reportedly took over 45 minutes to arrive at the scene. In a state as dense, chaotic, and incident-prone as Lagos, those minutes often mean the difference between life and death.

What happened?
“Maintenance died. Priorities shifted. Square pegs found their way into round holes,” says Ifeoma bitterly. “When those who don’t understand emergency health are put in charge of emergency health, this is what you get,” Ifeoma said gloomily.

She points to a larger pattern across the state’s healthcare infrastructure: grand policy announcements followed by poor execution, procurement-driven governance that prioritises new assets over sustaining the old, and a lack of accountability for failures.

“An ambulance isn’t just a vehicle. It’s a mobile ICU. It needs fuel. Servicing. Skilled paramedics. If you treat it like a bus, it becomes a bus.”

Not just broken, forgotten
In several parts of Lagos that once had stationed ambulances, including Ojota, Surulere, Epe, and densely populated areas like Mushin and Alimosho, many LASAMBUS outposts have reportedly become inactive or abandoned.

The sight of a siren-sounding, oxygen-fitted rescue vehicle has become rare.

And with its disappearance, Lagosians have reverted to private alternatives or, worse, improvised solutions.

“People now carry accident victims in Keke NAPEPs. In wheelbarrows. On bikes,” Ifeoma says, her voice thickening. “All this, in 2025, in the same Lagos that once had one of the most responsive ambulance systems in the country.”

Call for inquiry, demand for reform
Health experts are calling for an independent audit into the current state of LASAMBUS.

How many ambulances are functional? How many are parked and abandoned? Who is responsible for oversight? What happened to the collaboration with LASEMA?

“We don’t need new press releases. We need working engines. We need trust rebuilt,” noted a medical practitioner at the state’s teaching hospital, who spoke on condition of anonymity because he is not authorised to speak to the media.

In 2022, the Lagos State government, in a public statement published on its website, said the growing demands of urbanisation and industrialisation have made it intensify efforts to improve emergency medical response through two key services: the Lagos State Emergency Medical Services (known as LASEMS) and LASAMBUS.

Originally inherited as a base hospital system, LASEMS has been strengthened to support in-hospital care, while LASAMBUS, established in March 2001, provides crucial pre-hospital emergency response across the state.

Both services, according to the report, should operate round-the-clock and have been instrumental in improving emergency response times, reducing preventable deaths, and enhancing the quality of trauma and medical care in the state.

LASAMBUS response time below global standards
A 2020 study revealed an average response time of 17 minutes, ranging from seven to 60 minutes, which experts have said was too lengthy relative to global standards.

Factors contributing to delays include traffic congestion (60 per cent), poor incident descriptions (18 per cent), and distance (seven per cent), according to BioMed Central, a public health repository.

In 2019, for instance, LASAMBUS only responded to 37.1 per cent of road traffic accident calls, hindered by poor infrastructure, unfitted vehicles, and dispatch coordination issues.

A performance evaluation of LASAMBUS in 2019 concluded that response rates to RTAs between December 2019 and May 2018 were significantly lower when compared to global standards.

The evaluators had to sift through many illegible forms to make several conclusions. The most jarring of these was that the most common outcomes for RTA calls to LASAMBUS were ‘Crash Already Addressed’ and ‘Did Not Respond’.

Some of the reasons cited for ‘Crash Already Addressed’ were ‘Unknown’ (81.9 per cent), ‘Responded to by Police’ (3.1 per cent), ‘Self-Evacuated’ (2.7 per cent) and ‘Attended to by LASEMA or LRU’ (Lagos State Emergency Management Agency or LASEMA Response Unit).

Other reasons for not responding included ‘no fuel’, ‘no ambulance available’ and ‘found RTA victim already died’.

The causes of the delays that led to the aforementioned outcomes reflect familiar concerns often voiced by Lagosians, including uncertainty about who to call during emergencies, poor road conditions, traffic congestion, long distances, and faulty ambulances, all of which were cited by LASAMBUS staff.

It is no wonder that the mortality rate from RTAs in Nigeria is significantly high.

Every year, there are approximately 20.6 deaths per 100,000 people in Nigeria due to RTAs; this is in comparison to 10.8 deaths per 100,000 people in the UK and 2.9 deaths per 100,000 people in the US.

Sadly, most people in the country only rely on ambulance services to transport corpses to morgues, or during epidemics, to transport patients to isolation or care centres.

A former Deputy Head of Medical Information at Aspen Pharma Group, Dr Helen Zidon, said the wide gap in pre-hospital emergency resources in the country is being filled by privately owned ambulance services, such as Critical Rescue International in Ikeja, 0700 Ambulance Services in Lekki, Ambulance Nigeria in Victoria Island and Braingrace Medical Services in Surulere, among others.

She said, “In that same year, 2019, the Nigerian Communications Commission recently announced that they would be undertaking the task of facilitating the development of Emergency Communications Centres in all 36 states.

“The plan was to ensure that all telecom operators are mandated to route emergency calls through the dedicated three-digit toll-free number, 112, from each state to the emergency centre within that state.

“The state operators will then process the distress call and contact the relevant Emergency Response Agency (e.g. Fire Service, Police, FRSC, Ambulance, etc.) whose primary duty is to handle the case.”

Not sure what happened to this move, but not much has been heard about it since then.

What to do during emergencies in Lagos
Lagos remains the only Nigerian state with a functional emergency medical service that includes a Public Safety Answering Point, placing it ahead of other states in terms of formal emergency response infrastructure.

Despite this relative advantage, the city’s emergency response times still fall below global standards.

In Abuja, this figure extends to 60 minutes. Across the country, only 12 per cent of emergency calls receive timely responses.

In contrast, some private and non-governmental emergency medical systems in Nigeria demonstrate better performance.

Eight Medical, a private first responder service, boasts an average response time of 10 minutes, having responded to over 15,000 calls and reportedly saved 8,000 lives. However, it continues to face challenges, including attacks in semi-urban areas.

Flying Doctors Nigeria offers air ambulance services with a fleet of 20 aircraft and 47 staff. The service caters primarily to clients who can afford its premium offerings.

Additionally, organisations like Trauma Care International Foundation and LFR International have stepped in to bridge the response gap through training.

These groups have trained over 350 paramedics in Lagos and more than 1,000 Federal Road Safety Corps personnel nationwide, aiming to improve first response across critical locations.

While progress has been made, these figures underscore the urgent need for expanded, equitable, and better-coordinated emergency care systems across Nigeria.

During emergencies, residents are advised to please call the toll-free emergency hotline at 112 for all police vehicles, ambulances, fire trucks, etc services.

Lagos govt mute
Efforts to contact the Lagos State Ministry of Health proved futile, as calls to the spokesperson, Tunbosun Ogunbanwo, rang out. Text and WhatsApp messages were also not responded to.

An email sent to the ministry’s official address ([email protected]) at 6:52 am on Wednesday, June 9, 2025, had yet to be replied to as of press time on Friday.

Similarly, the Permanent Secretary of the Lagos State Emergency Management Agency, Dr Femi Oke-Osanyintolu, did not respond to calls, text messages, or WhatsApp messages.

Efforts to reach the Director of LASAMBUS, Mrs Wuruola Makinde, were also unsuccessful.

New ambulances unveiled
In what appears to be an official acknowledgement of the state’s declining emergency response capacity, the Lagos State Government, on Friday, unveiled 10 new pre-fabricated ambulance points under the LASAMBUS scheme.

The move, according to the government, is seen as a corrective step to boost the state’s struggling pre-hospital care system, which has faced mounting criticism over delayed response times and deteriorating infrastructure.

Unveiled by the Special Adviser to the Governor on Health, Dr Kemi Ogunyemi, the newly established ambulance bases are located in Agege, Agbowa, Masha (Surulere), Badagry, Mile 2, Epe, Shomolu, Igando, Iba, and Ibeju-Lekki, areas previously identified as underserved.

At a commissioning ceremony held at the Agege LASAMBUS Point, Ogunyemi admitted the need to “significantly improve” emergency healthcare access in Lagos, noting that the development aligns with the Babajide Sanwo-Olu administration’s THEMES+ agenda.

“These new ambulance points represent not just infrastructure, but renewed hope and access to lifesaving care,” she said, adding that situating the units closer to communities will help reduce response times in critical situations.

Also in attendance were top officials from the Ministry of Health, including Permanent Secretary Dr Olusegun Ogboye, and representatives from the contractor, Hamibra Integrated Nigeria Ltd.

Observers say the government’s actions signal a tacit recognition of previous lapses in emergency medical delivery, and an attempt to restore public confidence in LASAMBUS.